Thursday, March 22, 2012

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Alcohol, Drug and Mental Health Services (ADMHS), the county department responsible for providing mental health treatment to MediCal beneficiaries (as well as the uninsured, to the extent it can), has long needed help, and the Board of Supervisors Tuesday seemed to say enough is enough.

When confronted with the news that department officials don’t know how to cover a more than $3-million deficit, the supervisors basically told them to figure it out, and figure it out while not cutting care for the indigent population the department serves. Additionally, the supervisors said, they’d like to establish a blue-ribbon commission made up of stakeholders outside of the department and outside of the Mental Health Commission to take a deep look into what has been plaguing ADMHS for years.

This came after a two-hour presentation to the board that focused a lot on finances but with little talk about actual performance measures. And when performance was talked about, it was scary. For instance, staff outlined a percentage of Medicare recipients who had exhausted their lifetime number of days they were eligible for care, a sign the system is not working as it should. “I’ve been listening to mental health problems for 14 years now, and things don’t seem to get much better,” 4th District Supervisor Joni Gray said.

ADMHS served 4,737 adults and 2,892 children last year, including treatment at department and CARES (Crisis and Recovery Emergency Services) clinics. The department submits nearly 300,000 claims to the state each year, and provisional reimbursements are given based on those claims.

Department officials will be back in front of the supervisors for a May update in advance of the June budget hearings as the county figures out how to deal with the fiscal side of things. The department is currently $6.4 million in the hole and expects to be at a $3.5-million deficit when the year ends. It sounds bad, but the department is actually on the mend from where it was four years ago and has made significant progress to right the ship, with the help of the Auditor-Controller’s Office.

Years down the road — as many as five or six years later — the state Department of Mental Health audits the reimbursements it gives out each year. And that’s when Santa Barbara’s troubles began, in 2007-2008, when county officials began to realize their missteps. From fiscal year 2002-2003 through fiscal year 2006-2007, the department had used incorrect billing methods, resulting in increased cash flow during those periods. But when it realized it had issues, the amount owed to the state quickly added up.

The department self-disclosed the billing problem to the state to the tune of $9.3 million. Furthermore, ADMHS had been billing a program known as MISC (Multi-Agency Integrated Service of Care) to MediCal, even though it wasn’t a billable MediCal program since a grant funding mental health services ran out. That left the department an additional $12.2 million in the hole. Combined with a $7-million budget shortfall and another $7.8 million in annual state cost settlements, the multiple issues added up to a $36.3-million bill for ADMHS director Dr. Ann Detrick and her crew to deal with.

The county is still in the process of appealing much of that tab and negotiating with the state on how much it still has to pay. The supervisors have been setting apart pieces of its reserve to pay off those bills once the time comes. The final tally should be clearer when ADMHS officials are back in front of the board in May.

Going forward, county officials continue to take a look at operational enhancements to keep up with changes at both the state and federal level. One suggestion on the table is combining ADMHS with the Public Health Department. There is a lot of overlap between the two, for example, when working with the chronically homeless, and efficiencies could possibly be achieved by a merger of the two departments, at a possible savings to the county.

There also is positive news from the federal government. The Affordable Care Act provides expansion of Medicaid to people with mental health issues who do not currently qualify for mental health MediCal. So the county could see more reimbursement dollars as a result of this change.

Comments

Sheriff Brown and the California Correctional Peace Officers Association have taken over the management of the mentally ill. The County wants to give Sheriff Brown and his buddies $26 million for the jail house in Santa Maria. Das Williams wants to give his union buddies $60 million.

Das and the county supervisors know that the mentally ill don't vote, but the police and prison unions do. Never mind that it costs more or that prison guards don't make good mental health workers.

One of the suggestions in the meeting was to "get rid of extra help" positions. That shows a misunderstanding of what "extra help" means.

It doesn't mean that extra people are hanging around. It means that when regular staff are sick, on vacation or the case load increases the "extra help" staff can be called to work.

Extra help staff receive an hourly wage. No benefits. No insurance. No retirement. No vacation. No unit cash.

And if you have to call an agency for the assistance needed you will pay a higher hourly rate for a temporary person who is unfamiliar with the setting, routines and patients. AND who cost much more than the already trained extra help staff.

Again, another example of the BOS having the opportunity to take the lead and make the hard calls, and punting. $3,000,000 deficit and telling the staff to solve the problem without cutting services??? What color is the sky on their planet???? It sure isn't blue like it is here. Failed fiscal leadership yet again. They micro manage departments that were better off without their intervention (Parks) and hide under a rock with departments like this that need leadership.

Sure, another blue ribbon committee made up of advocates who support their specific constituents (nothing wrong with this), but who is going to support elimination of services to their specific core of advocates?

In case you fiscally challenged lightweights don't remember, the budget process starts in less than 2 months for next year and the $17 million hole to fix in addition to this.

The Supes don't have a clue and neither does ADMHS administration. If they did, the CAO would not think that a consultant is the answer. They just closed an RFP bid process to identify someone to tell the county how to find their way out of this mess. Most telling is the ambiguity in the RFP. I don't think they really know what the problem is. I am also pretty confident they won't want to spend the money it takes to do get solid data.